Nursing

To improve the health of people and communities through accessible, quality care.

Community Mobile Radiology Unit

Southern New Hampshire University

Hello, my name is XXXX. Welcome to this meeting on Community Mobile Radiology Unit proposal.

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Introduction

Venice Family Clinic started in 1970 by Philip Rossman, MD (founder) and Mayer B. Davidson, MD (co-founder) in a borrowed storefront dental office

Venice Family Center (VFC) a non-profit, private, community-based clinic including: 12 locations, 370 staff members and 1,371 volunteers

Provides comprehensive services including primary care, behavioral health services, dental and vision care

75% of clientele live below poverty line and 16% are homeless

Venice Family Clinic (VFC) is a community health facility that provides health care to those people in need (i.e. homeless and/or low-income). Currently 75% of the clientele treated by VFC live below the poverty line and about 16% are homeless. The present comprehensive services provide specialized treatment in various specialties, but their current Street Medicine program is diversified and an area of growth and progress.

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Financial Status of the Organization

VFC’s current ratio for 2018 is 22.05. Current assets ($24,286,070) ÷ current liabilities (1,101,514).

VFC’s 2017 ratio = 14.93 (18,078,363 ÷ 1,210,695). Increase in the ratio shows financial stability and growth.

Revenue: insurance reimbursements, grants, donations, and additional subsidized by state and federal resources.

Largest portion of reimbursements received from “third-party” vendors and grants.

Improvement in care associated to the increase in assets from 2017 to 2018 of $6 million.

Reduction in liabilities total $359,000

Based upon the annual report from 2018 the acknowledged current ratio from 2017 to 2018 shows a growth from 14.93 to 22.05. These numbers reflect financial stability within the organization and growth/progress. Primary reimbursement received from “third-party” vendors with additional revenue acquired from grants , donations, scholarships, and federal/state subsidizing.

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Current Healthcare Trends

There are various healthcare trends impacting the operations of many healthcare organizations. First and foremost technology has affected how information is collected, organized, and then disseminated within any healthcare organization. Using technology to provide access to the impoverished and homeless population is now readily available through mobile medical clinics and now mobile radiology units. Using state-of-the-art equipment we can now receive test results quickly and efficiently and reduce duplication of orders. Another trend that influenced healthcare is the transition to “value-based purchasing” not only in hospitals but also smaller clinics and private practices. Providing care and services based upon quality instead of quantity has affected healthcare outcomes. Access to mobile units can decrease the risk of health complications for at-risk populations and impact the health issues within the community.

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Technology improves access to resources within the community.

Reduces duplication of ordering tests/labs.

Decreases time-frame for results processing and reporting

Value-based purchasing impacts the access and availability to testing

“Value-based programs, they are part of a larger government effort to pay providers for quality rather than quantity by providing better care for individuals, better health for populations, and lower cost” (Nowicki 2018, pg. 209)

Decreasing the risk of health complications for the homeless and poor communities can impact the health issues for society

Strategic Goals

Providing comprehensive health care that includes medical, dental, and mental health treatments for “pediatrics, general adult medicine, women’s, senior, homeless, and chronic care services” (VFC 2018)

Street Medicine program providing “house calls for people without a home.” Additional services to include mobile radiology services to the low income and homeless population will improve treatment options. (VFC 2018)

Most reimbursement received from Medicare/Medicaid and private health services (third-party payer) in addition to grants, scholarships, and financial aid which are impacted by government policies such as the Affordable Care Act which provides a large portion of our support. Current policy changes or repeal of the ACA would impact outpatient services such as radiologic testing

“Increased numbers of uninsured patients, together with both the loss of Medicaid revenues associated with the Medicaid expansion and most federal grant funding, would be a severe financial shock to health centers and likely leave them unable to sustain their operations and capacity at current levels” (Rosenbaum, Paradise, Markus, Sharac, Tran, Reynolds, and Shin 2017)

Within VFC’s mission and vision “to improve the health of people and communities through accessible, quality care” (VFC 2018). Access to quality care improves the health and wellness of the community, but also increases rates of reimbursement. Reimbursement rates based upon specified quality care goals and diagnosis-related groups (DRGs) can be influenced by utilizing the current Street Medicine program and expanding on the services provided. Any changes to the government policies such as the Affordable Care Act (ACA) will impact any outpatient services VFC can provide. “Increased numbers of uninsured patients, together with both the loss of Medicaid revenues associated with the Medicaid expansion and most federal grant funding, would be a severe financial shock to health centers and likely leave them unable to sustain their operations and capacity at current levels” (Rosenbaum, Paradise, Markus, Sharac, Tran, Reynolds, and Shin 2017).

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Proposal for Community Mobile Radiology Unit

The current Street Medicine program provides necessary services within the impoverished community that would not otherwise be available. The ability to have basic radiologic testing in “real-time” reduces the time between assessment and treatment. Prevention of overworked staff it would be prudent to hire 2 additional staff members to operate the mobile radiologic unit to prevent delays in testing or lack of resources if short-staffed. Additionally the reduction in ER visits through the Street Medicine program and the mobile radiology unit can reduce misuse of resources and re-admission rates for those clients that can be maintained at “home”. Out-of-pocket expenses can also be reduced when not referring our clientele to an outside facility or affiliation.

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Mobile Radiology Units in conjunction with the Street Medicine program can also provide basic radiological services to the homeless & homebound population.

Tests including chest x-rays (CXR), hip, knee and/or ankle x-rays in cases of minor injuries.

Hiring 2 additional staff members to properly operate the mobile units and equipment and prevent overworking existing staff

Reduction in unnecessary uses of Emergency Centers for non-emergency visits and potentially decrease readmissions if timely outpatient monitoring can be maintained.

Addition of mobile radiology unit also decreases the out-of-pocket expenses for our clientele from affiliation fees using other healthcare facilities

Proposal for mobile radiology unit continued…

The purchase of a mobile radiology van/bus customized for outpatient radiologic services will increase the access of healthcare within the community. Additional fees will be associated with the purchase to include equipment/supplies, customization process, taxes, licensing and insurance fees. Equipped with laptop/computers with hotspots/WIFIF and connecting with the existing electronic health record (EHR) would maintain contact with the clinic community and access to the patient medical records.

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Mobile units include the purchase of van/truck that can be customized for specialized use.

Proposal includes purchasing the vehicle, equipment/supplies, customization fees, and taxes, licensing and insurance fees.

Mobile unit would include laptop/computers with hotspots and WIFI technology to maintain contact with clinics and access to patient medical records

Proposed Options

Reviewing dealers currently providing van/buses for mobile units like Odulair VFC can have the vehicle customized and equipped with the necessary supplies and materials for efficient and effective care. The best option for VFC would be to purchase the vehicle outright versus a used vehicle which could include additional maintenance costs and or additional fees if the vehicle needs modification. Leading a vehicle would create possible end of lease fees and most companies will not allow customization of a vehicle after the lease is signed. All options would include the hiring of 2 staff members to operate the vehicle and equipment.

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Purchase of one mobile X-ray van/bus (equipped) and the hiring of 2 X-ray technicians to staff the mobile unit

Lease a vehicle and have it customized with the necessary equipment. Up-front this would be a lower-cost item, but most leases do not cover any customization of a vehicle. Hiring of 2 radiology technicians will still be necessary to cover the operation of the unit

Purchase a used vehicle is an option but can come with many issues such as previous wear/tear, cost for repairs/adjustments or modifications and hiring 2 radiology technicians

Options continued…

Based upon Odulair website their customization process takes 26 weeks from start to finish which would provide ample time to retrieve the funds for purchase. The cost range depends upon the options selected but general cost is between $200,000-$350,000. Hiring 2 radiology technicians will ensure proper staffing of the unit at $99,000 per year.

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Purchase, installation/customization takes minimum 26 weeks for completion

Cost ranges between $200,000-350,000 depending on the specific equipment, features/options.

Hiring 2 Radiology technicians: approximately $99,000/year on average.

Leasing is possible but includes additional fees and possible end of lease fees

Purchase of used vehicle possible with potential additional fees applied to modifications, unknown wear/tear on the vehicle

Financial Research

Mobile Unit vehicles can be purchased or leased. Purchasing is the best option. Cost is variable depending on the vehicle chosen and customization

Access for the community to early testing improves diagnosis and treatment time.

Access for early testing is vital for not only the low-income population, but for those homebound who are unable to have needed follow-up testing

Unnecessary ER visits can be reduced through sharing the services between the Street Medicine Program and a Mobile Radiology Unit

Mobile services are influential in cost saving measures and improving health and wellness within the community

Mobile units are available for both purchasing or leasing but customization makes leasing the least feasible option. Many companies are available to assist in choosing and modifying the vehicle one site available included Odulair. Costs are variable depending on the options chosen but are within $200,000-350,000 range with varying sizes available.

“Higher demands are being placed on vehicles used for mobile medical needs…looking to outreach vehicles as a permanent part of their culture…requires that the vehicles last longer, making structural integrity and high-quality electrical systems imperative” (Blanchet 2008). Reliability is needed with the vehicle to withstand the demanding schedules needed to provide services within the community.

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